| NPI | 1134450869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME136965) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX EP10034290) |
| 207Q00000X Family Medicine (Licence: WI 62640-20) | |
| 208D00000X General Practice (Licence: FL ACN702) | |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2020-10-20 |